Brain Tumor

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Brain Tumor


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Overview

When most normal cells grow

old or get damaged, they die, and new cells take their place. Sometimes, this

process goes wrong. New cells form when the body doesn't need them, and old or



Overview

damaged cells don't die as they should. The buildup of extra cells often forms

a mass of tissue called a growth or tumor.

Primary brain tumors can be benign or malignant:

Benign brain tumors do not contain cancer cells:



Overview

Usually, benign tumors can be removed, and

they seldom grow back.

Benign brain tumors usually have an obvious

border or edge. Cells from benign tumors rarely invade tissues around them.



Overview

They don't spread to other parts of the body. However, benign tumors can press

on sensitive areas of the brain and cause serious health problems.

Unlike benign tumors in most other parts of

the body, benign brain tumors are sometimes life threatening.



Overview

Benign brain tumors may become malignant.

Malignant brain tumors (also called brain

cancer) contain cancer cells:

Malignant brain tumors are generally more

serious and often are a threat to life.



Overview

They are likely to grow rapidly and crowd

or invade the nearby healthy brain tissue.

Cancer cells may break away from malignant

brain tumors and spread to other parts of the brain or to the spinal cord. They



Overview

rarely spread to other parts of the body.

**Tumor Grade**

Doctors group brain tumors by grade.

The grade of a tumor refers to the way the cells look under a microscope:



Overview

Grade I: The tissue is benign. The cells

look nearly like normal brain cells, and they grow slowly.

Grade II: The tissue is malignant. The

cells look less like normal cells than do the cells in a Grade I tumor.



Overview

Grade III: The malignant tissue has cells

that look very different from normal cells. The abnormal cells are actively

growing (anaplastic).

Grade IV: The malignant tissue has cells



Overview

that look most abnormal and tend to grow quickly.

Cells from low-grade tumors (grades I and

II) look more normal and generally grow more slowly than cells from high-grade

tumors (grades III and IV).



Overview

Over time, a low-grade tumor may become a

highgrade tumor. However, the change to a high-grade tumor happens more often

among adults than children.

You may want to read the NCI fact sheet Tumor

Grade.



Overview**Types of Primary Brain

Tumors**

There are many types of primary brain

tumors. Primary brain tumors are named according to the type of cells or the




part of the brain in which they begin. For example, most primary brain tumors

begin in glial cells. This type of tumor is called a glioma.

Among adults, the most common types are:

Astrocytoma:




The tumor arises from star-shaped glial cells called astrocytes.

It can be any grade. In adults, an astrocytoma most often arises in the

cerebrum.

Grade I or II astrocytoma: It may be called




a low-grade glioma.

Grade III astrocytoma: It's sometimes

called a high-grade or an anaplastic astrocytoma.

Grade IV astrocytoma: It may be called a glioblastoma or

malignant astrocytic glioma.




Meningioma:

The tumor arises in the meninges. It can be grade I, II, or III. It's usually

benign (grade I) and grows slowly.

Oligodendroglioma:




The tumor arises from cells that make the fatty substance that covers and

protects nerves. It usually occurs in the cerebrum. It's most common in

middle-aged adults. It can be grade II or III.

Among children, the most common types are:




Medulloblastoma:

The tumor usually arises in the cerebellum. It's sometimes called a primitive

neuroectodermal tumor. It is grade IV.

Grade I or II astrocytoma: In children,




this lowgrade tumor occurs anywhere in the brain. The most common astrocytoma

among children is juvenile

pilocytic astrocytoma. It's grade I.

Ependymoma:




The tumor arises from cells that line the ventricles or the central canal of

the spinal cord. It's most commonly found in children and young adults. It can

be grade I, II, or III.

Brain




stem glioma: The tumor occurs in the lowest part of the brain. It can be a

low-grade or high-grade tumor. The most common type is diffuse

intrinsic pontine glioma .



Risks

When you're told that you have a brain tumor,

it's natural to wonder what may have caused your disease. But no one knows the

exact causes of brain tumors. Doctors seldom know why one person develops a



Risks

brain tumor and another doesn't.

Researchers are studying whether people

with certain risk

factors are more likely than others to develop a brain tumor. A risk



Risks

factor is something that may increase the chance of getting a disease.

Studies have found the following risk

factors for brain tumors:



Risks**Ionizing

radiation:**

Ionizing radiation from high dose x-rays (such

as radiation

therapy from a large machine aimed at the head) and other sources can



Risks**Ionizing

cause cell damage that leads to a tumor. People exposed to ionizing radiation

may have an increased risk of a brain tumor, such as meningioma or glioma.



Risks**Family history**

: It is rare for brain tumors

to run in a family. Only a very small number of families have several members

with brain tumors.

Researchers are studying whether using cell



Risks**Family history**

phones, having had a head injury, or having been exposed to certain chemicals

at work or to magnetic fields are important risk factors. Studies have not

shown consistent links between these possible risk factors and brain tumors,

but additional research is needed.



Symptoms

The symptoms of a brain tumor depend on

tumor size, type, and location. Symptoms may be caused when a tumor presses on

a nerve or harms a part of the brain. Also, they may be caused when a tumor



Symptoms

blocks the fluid that flows through and around the brain, or when the brain

swells because of the buildup of fluid.

-- These are the most common symptoms of brain

tumors:



Symptoms

-- Headaches (usually worse in the morning)

-- Nausea and vomiting

-- Changes in speech, vision, or hearing

-- Problems balancing or walking

-- Changes in mood, personality, or ability to



Symptoms

concentrate

-- Problems with memory

-- Muscle jerking or twitching (seizures or

convulsions)

-- Numbness or tingling in the arms or legs



Symptoms

Most often, these symptoms are not due to a

brain tumor. Another health problem could cause them. If you have any of these

symptoms, you should tell your doctor so that problems can be diagnosed and

treated.



Diagnosis

If you have symptoms that suggest a brain

tumor, your doctor will give you a physical exam and ask about your personal

and family health history. You may have one or more of the following tests:



Diagnosis

Neurologic exam:

Your doctor checks your vision, hearing, alertness, muscle strength,

coordination, and reflexes. Your doctor also examines your eyes to look for

swelling caused by a tumor pressing on the nerve that connects the eye and the



Diagnosis

brain.

MRI:

A large machine with a strong magnet linked to a computer is used to make

detailed pictures of areas inside your head. Sometimes a special dye (contrast



Diagnosis

material) is injected into a blood vessel in your arm or hand to help show

differences in the tissues of the brain. The pictures can show abnormal areas,

such as a tumor.

CT



Diagnosis

scan: An x-ray machine linked to a computer takes a series of detailed

pictures of your head. You may receive contrast material by injection into a

blood vessel in your arm or hand. The contrast material makes abnormal areas

easier to see. Your doctor may ask for other tests:



Diagnosis

Angiogram:

Dye injected into the bloodstream makes blood vessels in the brain show up on

an x-ray. If a tumor is present, the x-ray may show the tumor or blood vessels

that are feeding into the tumor.



Diagnosis

Spinal

tap: Your doctor may remove a sample of cerebrospinal fluid (the fluid that

fills the spaces in and around the brain and spinal cord). This procedure is

performed with local



Diagnosis

anesthesia. The doctor uses a long, thin needle to remove fluid from the

lower part of the spinal column. A spinal tap takes about 30 minutes. You must

lie flat for several hours afterward to keep from getting a headache. A



Diagnosis

laboratory checks the fluid for cancer cells or other signs of problems.

Biopsy:

The removal of tissue to look for tumor cells is called a biopsy. A pathologist looks

at the cells under a microscope to check for abnormal cells. A biopsy can show



Diagnosis

cancer, tissue changes that may lead to cancer, and other conditions. A biopsy

is the only sure way to diagnose a brain tumor, learn what grade it is, and

plan treatment. Surgeons can

obtain tissue to look for tumor cells in two ways:



Diagnosis

Biopsy at the same time as treatment: The

surgeon takes a tissue sample when you have surgery to remove part or all of

the tumor. See the Surgery section.

Stereotactic



Diagnosis

biopsy: You may get local or general

anesthesia and wear a rigid head frame for this procedure. The surgeon

makes a small incision in

the scalp and drills a small hole (a burr



Diagnosis

hole) into the skull. CT or MRI is used to guide the needle through the

burr hole to the location of the tumor. The surgeon withdraws a sample of

tissue with the needle. A needle biopsy may be used when a tumor is deep inside



Diagnosis

the brain or in a part of the brain that can't be operated on.

However, if the tumor is in the brain stem or certain other areas, the surgeon

may not be able to remove tissue from the tumor without harming normal brain tissue.



Diagnosis

In this case, the doctor uses MRI, CT, or other imaging tests to learn as much

as possible about the brain tumor.



Treatment

People with brain tumors have several

treatment options. The options are surgery, radiation

therapy, and chemotherapy.

Many people get a combination of treatments.



Treatment

The choice of treatment depends mainly on

the following:

-- The type and grade of brain tumor

-- Its location in the brain

-- Its size



Treatment

-- Your age and general health

For some types of brain cancer, the doctor

also needs to know whether cancer cells were found in the cerebrospinal fluid.

Your doctor can describe your treatment



Treatment

choices, the expected results, and the possible side

effects. Because cancer therapy often damages healthy cells and tissues,

side effects are common. Before treatment starts, ask your health care team

about possible side effects and how treatment may change your normal



Treatment

activities. You and your health care team can work together to develop a treatment

plan that meets your medical and personal needs.

You may want to talk with your doctor about

taking part in a clinical



Treatment

trial, a research study of new treatment methods. See the Taking Part in

Cancer Research section.

Your doctor may refer you to a specialist,

or you may ask for a referral. Specialists who treat brain tumors include neurologists, neurosurgeons, neuro-oncologists, medical



Treatment

oncologists, radiation

oncologists, and neuroradiologists.

Your health care team may also include an oncology

nurse, a registered

dietitian, a mental



Treatment

health counselor, a social

worker, a physical

therapist, an occupational

therapist, a speech

therapist, and aphysical



Treatment

medicine specialist. Also, children may need tutors to help with

schoolwork. (The Rehabilitationsection

has more information about therapists and tutors.)



Treatment**Surgery**

Surgery is the usual first treatment for

most brain tumors. Before surgery begins, you may be given general anesthesia,

and your scalp is shaved. You probably won't need your entire head shaved.




Surgery to open the skull is called a craniotomy.

The surgeon makes an incision in your scalp and uses a special type of saw to remove

a piece of bone from the skull.

You may be awake when the surgeon removes




part or all of the brain tumor. The surgeon removes as much tumor as possible.

You may be asked to move a leg, count, say the alphabet, or tell a story. Your

ability to follow these commands helps the surgeon protect important parts of

the brain.




After the tumor is removed, the surgeon

covers the opening in the skull with the piece of bone or with a piece of metal

or fabric. The surgeon then closes the incision in the scalp.

Sometimes surgery isn't possible. If the




tumor is in the brain stem or certain other areas, the surgeon may not be able

to remove the tumor without harming normal brain tissue. People who can't have

surgery may receive radiation therapy or other treatment.

You may have a headache or be uncomfortable




for the first few days after surgery. However, medicine can usually control

pain. Before surgery, you should discuss the plan for pain relief with your

health care team. After surgery, your team can adjust the plan if you need more

relief.




You may also feel tired or weak. The time

it takes to heal after surgery is different for everyone. You will probably

spend a few days in the hospital.

Other, less common problems may occur after




surgery for a brain tumor. The brain may swell or fluid may build up within the

skull. The health care team will monitor you for signs of swelling or fluid

buildup. You may receive steroids to

help relieve swelling. A second surgery may be needed to drain the fluid. The




surgeon may place a long, thin tube (shunt)

in a ventricle of the brain. (For some people, the shunt is placed before

performing surgery on the brain tumor.) The tube is threaded under the skin to

another part of the body, usually the abdomen. Excess fluid is carried from the




brain and drained into the abdomen. Sometimes the fluid is drained into the

heart instead.

Infection is another problem that may

develop after surgery. If this happens, the health care team will give you an antibiotic.




Brain surgery may harm normal tissue. Brain

damage can be a serious problem. It can cause problems with thinking, seeing,

or speaking. It can also cause personality changes or seizures. Most of these

problems lessen or disappear with time. But sometimes damage to the brain is




permanent. You may need physical therapy, speech therapy, or occupational

therapy. See the Rehabilitation section.



Treatment**Radiation Therapy**

Radiation therapy kills brain tumor cells

with high-energy x-rays, gamma

rays, or protons.

Radiation therapy usually follows surgery.




The radiation kills tumor cells that may remain in the area. Sometimes, people

who can't have surgery have radiation therapy instead.

Doctors use external and internal types of

radiation therapy to treat brain tumors:




External

radiation therapy: You'll go to a hospital or clinic for treatment. A large

machine outside the body aims beams of radiation at the head. Because cancer

cells may invade normal tissue around a tumor, the radiation may be aimed at




the tumor and nearby brain tissue, or at the entire brain. Some people need

radiation aimed at the spinal cord also. The treatment schedule depends on your

age, and the type and size of the tumor. Fractionated external beam therapy is




the most common method of radiation therapy used for people with brain tumors.

Giving the total dose of radiation over several weeks helps to protect healthy

tissue in the area of the tumor. Treatments are usually 5 days a week for




several weeks. A typical visit lasts less than an hour, and each treatment

takes only a few minutes. Some treatment centers are studying other ways of

delivering external beam radiation therapy:

Intensity-modulated




radiation therapy or 3-dimensional

conformal radiation therapy: These types of treatment use computers to more

closely target the brain tumor to lessen the damage to healthy tissue.

Proton




beam radiation therapy: The source of radiation is protons rather than

x-rays. The doctor aims the proton beam at the tumor. The dose of radiation to

normal tissue from a proton beam is less than the dose from an x-ray beam.

Stereotactic




radiation therapy: Narrow beams of x-rays or gamma rays are directed at the

tumor from different angles. For this procedure, you wear a rigid head frame.

The therapy may be given during a single visit (stereotactic

radiosurgery) or over several visits.




Internal

radiation therapy (implant

radiation therapy or brachytherapy):

Internal radiation isn't commonly used for treating brain tumors and is under




study. The radiation comes fromradioactive material

usually contained in very small implants called seeds. The seeds are placed

inside the brain and give off radiation for months. They don't need to be

removed once the radiation is gone.




Some people have no or few side effects

after treatment. Rarely, people may have nausea for several hours after

external radiation therapy. The health care team can suggest ways to help you

cope with this problem. Radiation therapy also may cause you to become very




tired with each radiation treatment. Resting is important, but doctors usually

advise people to try to stay as active as they can.

Also, external radiation therapy commonly

causes hair loss from the part of the head that was treated. Hair usually grows




back within a few months. Radiation therapy also may make the skin on the scalp

and ears red, dry, and tender. The health care team can suggest ways to relieve

these problems.

Sometimes radiation therapy causes brain




tissue to swell. You may get a headache or feel pressure. The health care team

watches for signs of this problem. They can provide medicine to reduce the

discomfort. Radiation sometimes kills healthy brain tissue. Although rare, this




side effect can cause headaches, seizures, or even death.

Radiation may harm the pituitary

gland and other areas of the brain. For children, this damage could

cause learning problems or slow down growth and development. In addition,




radiation increases the risk of secondary tumors later in life.

**Chemotherapy**

Chemotherapy, the use of drugs to kill

cancer cells, is sometimes used to treat brain tumors. Drugs may be given in




the following ways:

By mouth or vein (intravenous):

Chemotherapy may be given during and after radiation therapy. The drugs enter

the bloodstream and travel throughout the body. They may be given in an




outpatient part of the hospital, at the doctor's office, or at home. Rarely,

you may need to stay in the hospital. The side effects of chemotherapy depend

mainly on which drugs are given and how much. Common side effects include




nausea and vomiting, loss of appetite, headache, fever and chills, and

weakness. If the drugs lower the levels of healthy blood cells, you're more

likely to get infections, bruise or bleed easily, and feel very weak and tired.




Your health care team will check for low levels of blood cells. Some side

effects may be relieved with medicine.

In wafers that are put into the brain: For

some adults with high-grade glioma, the surgeon implants several wafers into




the brain. Each wafer is about the size of a dime. Over several weeks, the

wafers dissolve, releasing the drug into the brain. The drug kills cancer

cells. It may help prevent the tumor from returning in the brain after surgery




to remove the tumor. People who receive an implant (a wafer) that contains a drug

are monitored by the health care team for signs of infection after surgery. An

infection can be treated with an antibiotic

http://www.cancer.gov/cancertopics/wyntk/brain/page7



Rehabilitation

Rehabilitation can be a very important part

of the treatment plan. The goals of rehabilitation depend on your needs and how

the tumor has affected your ability to carry out daily activities.



Rehabilitation

Some people may never regain all the

abilities they had before the brain tumor and its treatment. But your health

care team makes every effort to help you return to normal activities as soon as

possible.



Rehabilitation

Several types of therapists can help:

-- Physical therapists: Brain tumors and their

treatment may cause paralysis.

They may also cause weakness and problems with balance. Physical therapists



Rehabilitation

help people regain strength and balance.

-- Speech therapists: Speech therapists help

people who have trouble speaking, expressing thoughts, or swallowing.

-- Occupational therapists: Occupational



Rehabilitation

therapists help people learn to manage activities of daily living, such as

eating, using the toilet, bathing, and dressing.

-- Physical medicine specialists: Medical

doctors with special training help people with brain tumors stay as active as



Rehabilitation

possible. They can help people recover lost abilities and return to daily activities.

Children with brain tumors may have special

needs. Sometimes children have tutors in the hospital or at home. Children who



Rehabilitation

have problems learning or remembering what they learn may need tutors or

special classes when they return to school.


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Brain Tumor